NJEM Commentary Underscores Controversy on E-Cigarettes

Is it possible that e-cigarettes are part of the public health solution and not just another way to trap young people into smoking? Are they a pathway to ending tobacco cigarette use or a dangerous product that could undermine efforts to reduce smoking?  In a careful and comprehensive analysis of the emerging controversy and evidence, Drs. Amy Fairchild, PhD, MPH, Ronald Bayer, PhD, and James Colgrove, PhD, MPH, published the commentary, The Renormalization of Smoking? E-Cigarettes and the Tobacco "Endgame,” in the New England Journal of Medicine where they wade into this contentious debate.

Sales of e-cigarettes are estimated to reach $1.7 billion in the United States in 2013 alone, and numbers released from the Centers for Disease Control show that twice as many young people tried them in 2012 compared to 2011. With e-cigarette sales growing, some predict that sales may eventually surpass that of tobacco cigarettes. Therefore it is no surprise that the role of e-cigarettes is leading to intense public health debate.

Although the jury is still out on e-cigarettes and broader population-level smoking patterns, the handful of studies suggest that the majority of people who use e-cigarettes treat them as cessation aides and report that they have been key to quitting smoking.

While Professors Fairchild, Bayer, and Colgrove are supportive of e-cigarettes as a vital harm reduction measure, they call on states to ban the sale of e-cigarettes to minors and urge the FDA to move swiftly to regulate them so that their potential harms can be better understood. Given the evidence and the known toll of smoking, enacting sweeping prohibitions while we wait for more data will come at a cost in lives. The potential benefits to tobacco smokers outweigh the risks.